The Worksite Wellness Program management world is evolving rapidly. Each month, there are new research findings that support the premise that Worksite Wellness Programs and disease management have a long-term impact on health care costs. Many large businesses that started Worksite Wellness Programs three to five years ago are showing savings in health, disability, and workers compensation costs. Small to mid-size businesses are watching all this and wondering where to start with wellness.

Getting senior management support and budget approval is one of the challenges at the beginning of a Worksite Wellness Program. This is the case because Worksite Wellness Programs can be expensive, averaging $150-300 per staff member per year in large businesses. Most of the savings are not realized for a number of years. This long-term investing is hard for businesses on the move.

The key to success for Worksite Wellness Programs is to take a strategic approach. Here are ten steps to consider when starting a Worksite Wellness Program.

1. Begin with senior management. Without senior management support, a health promotion strategy can fall flat. Begin with the health of your executive team and discover your wellness champions at the top of the organization.
2. Assess the problem. Look at your health care claims and analyze the trends. Which conditions are driving your medical, disability, and workers’ compensation claims and which are modifiable? What’s worked and what hasn’t thus far? What is the long-term impact of doing nothing?
3. Hold an initial wellness meeting. Invite your key stakeholders both inside and outside the organization. Ask your broker to facilitate the meeting and invite key health vendors including health, disability, Employee Assistance Program (EAP), fitness, and occupational nursing. Review claims and utilization information and identify key areas of concern. Look at current offerings and see how they can be tailored to the needs of the population.
4. Look at both healthy and unhealthy employees. Since 85% of claims are usually attributed to 15% of claimants, it is essential to reach those with the most costly conditions while also reaching individuals who are at risk for developing preventable diseases in the future. Voluntary Worksite Wellness Programs such as lunch & learn wellness seminars miss many of the individuals who need them most. Look at programs that are population-wide or target intact workgroups. Wellness incentives help but do not motivate everyone.
5. Establish short-term goals for the Worksite Wellness Programs. Establish some realistic short-term goals based on your key areas of concern. Are there any plan design changes that could have an immediate impact on spending? Are there some programmatic actions that could have immediate results?
6. Determine what employees are thinking. Hold some focus groups to determine where individuals are with wellness. What’s working? What isn’t? How much interest do individuals have in the Worksite Wellness Programs? What obstacles and barriers are employees experiencing when they try to change behavior?
7. Ensure that you have a high-impact Employee Assistance Program (EAP). Your first wellness dollars should go into upgrading your Employee Assistance Program (EAP). A highly utilized Employee Assistance Program (EAP) can provide a foundation for all of your future wellness activities. A good Employee Assistance Program (EAP) is a trusted link to the hearts and minds of employees. At no additional cost, the Employee Assistance Program (EAP) can provide needed follow-up coaching and personal attention for employees who are working on modifiable health behaviors or involved in disease management programs. Nutritionists, fitness, pregnancy, and stress management specialists are all part of a high-value Employee Assistance Program (EAP).
8. Establish three to five year goals for health care savings and measure them. Get help from your broker and insurance carrier help you on long-term goals for your health, disability, and workers compensation plans. Create program metrics that will help you to measure ROI. Go beyond participation rates, completion rates and program satisfaction. Measure changes in readiness, changes in behavior, and changes in risk factors. Create rigorous methods to measure health care savings over the long term.
9. Establish goals for organizational health. Look at the more intangible benefits of a wellness initiative and quantify them whenever possible. Include staff member turnover rates, cost of new hires, staff member morale, benefit satisfaction information, and employer of choice issues in setting goals. Create ways to measure success in these areas.
10. Add specifics to your short and long-term plan. Include a Worksite Wellness Program strategy, a communication strategy, and a Worksite Wellness Program incentive strategy that will fit with your corporate culture. Focus on integration of related components along a health continuum with communications that are focused, simple, and human. Create a budget that includes key components such as consumer education, health promotion, health risk assessments, and regular biometric screens.

Employers can also benefit from Worksite Wellness Programs. According to recent research, employers’ benefits are:

• Enhanced recruitment and retention of healthy employees
• Reduced health care costs
• Decreased rates of illness and injuries
• Reduced staff member rates of absence
• Improved staff member relations and morale
• Increased productivity

A U.S. Department of Health and Human Services report revealed that at worksites with physical activity programs as components of their Worksite Wellness Programs have:

• Reduced health care costs by 20 to 55%
• Reduced short-term sick leave by six to 32%
• Increased productivity by two to 52%

Thanks to modern medicine, life expectancy for Americans has continually increased. How much we enjoy these additional years, however, depends greatly on how we have lived our lives. If our quality of life is to remain high so that we can fully enjoy these extra years, we must practice good eating habits, be active and refrain from using tobacco products.

Furthermore, stress, distractions and the pressures of the job can take its toll on the staff member, which makes it important that a Worksite Wellness Program is implemented. Today, all across America, Canada, Europe and Asia, top Worksite Wellness Programs are being used to help improve staff member conditions at work and reduce the cost of worker health care.

Some of the top Worksite Wellness Programs currently in use today include:

Health Risk Assessments (HRAs)

Health Risk Assessment is a top Worksite Wellness Program currently in use globally. Organizations that implement it determine the safety and health concerns of workers by the assessment of appropriateness of the facilities and equipment against the needs of the employees.

It can, by way of example, guide the organization into determining how much air quality within an office room affects the users and then help the assessment team to come up with the measures necessary to correct the problem. An HRA can also evaluate the level of exposure workers have to certain hazardous or dangerous materials and practices.

Immunizations

This isn’t always practiced in every country since there are regions where government sponsored immunization shots are available. However, it has also become an important component of the top Worksite Wellness Programs in many businesses in North America.

Immunization, flu shots, such as those used to combat flu, by way of example, are offered to workers for free.

Employee Assistance Programs (EAPs)

Employee Assistance Programs (EAPs) consist of a wide variety of services. It can range from providing educational resources to employees regarding health issues to sponsoring health services and medical care. In many businesses, medical and insurance have also become a staple part of their benefits system.

Weight Management Programs

This is another Worksite Wellness Program that businesses use, particularly those that offer in-house commissary or cafeteria services. Instead of serving richer, high-calorie fare, cafeterias offer options for a healthier diet, usually in the form of low-calorie foods and sugar substitutes.

Employee Wellness Newsletters – Health Education Programs

One of the top Worksite Wellness Programs that businesses can implement is a self-powered tool using a newsletter to promote wellness, coupled with a visible campaign. The campaign may be done periodically and focus on a specific topic, such as smoking hazards, cancer, stress, carpal tunnel syndrome, safety in the workplace, etc.

The newsletter in itself can be an effective means to deliver information to employees or members of an organization but it is far from perfect. Some employees, by way of example, may not read the newsletter in its entirety or even pay attention to it. If the issues outlined in the newsletter are promoted through an active and highly visible campaign, it will be easier to maximize positive results.

Physical Fitness and Exercise Programs

Another top health promotion program for businesses is one that involves physical activities. Companies frequently sponsor exercise-related events such as marathons and organization sports programs to encourage employees to remain fit or lose excess weight. In mid- to large-sized businesses, businesses may even pay for gym memberships or in-house exercise facilities.

Worksite Wellness Program Incentives

Some of the top Worksite Wellness Programs implemented by businesses involve incentive rewards. This involves organization-sponsored programs that reward employees for achieving specific wellness goals. Participation in health campaigns and signing up for Worksite Wellness Programs are two of the most commonly rewarded schemes. Rewards can range from special recognitions to points (for bigger rewards) to specific gifts. In a few cases, cash may also be used.

However, incentive systems have had mixed reactions and levels of success. But it continues to be one of the top choices among businesses who are willing to modify it in order to fit their unique needs.

Group Activities

In many businesses, businesses take advantage of peer pressure in order to encourage workers to take part in Worksite Wellness Programs. This is currently one of the favorite worker Worksite Wellness Programs currently in use today and growing in popularity. Peer pressure is frequently leveraged to help promote competitions and to persuade employees to be active in organization-sponsored health fairs.

Worksite Wellness Programs: The Good

• A sampling of ROI for Worksite Wellness Programs: Bank of America: 600 percent; General Motors:370 percent; Pepsico: 300 percent; Citibank: 465 percent; and the Washoe County School District leading the pack at a whopping 1,560%. (Campbell,J., Wellness Improvement Experts, www.wellnessimprovementexperts.com, Albuquerque, New Mexico.)
• Companies with Worksite Wellness Programs have realized a 28% reduction in sick leave, a 26% reduction in adjunctive health care costs and a 30% reduction in disability and workers compensation costs. (Health Affairs, Volume 21, No.2, March, 2002.)
• The Washoe county School District in Northern Nevada realized a $15.60 ROI for every dollar spent due to a 20% reduction in rates of absence. (Hardy,A. (2005). At the Top Of The Class. WELCOA’s Absolute Advantage Magazine, 5(1), 14-20.)
• Worksite Wellness Programs provide the structure, encouragement, incentives and ongoing support that many individuals need in order to make lifestyle changes.
• Employees also realize returns on their efforts. FiServ, a financial services technology organization, gave employees who filled out a health risk assessment a significant discount on their health insurance premium. (Holland, Kelley, The New York Times, July 22, 2007.)

Worksite Wellness Programs: The Bad

The flip side of the argument centers on basic human rights. Do we want/need our employer to tell us to eat our veggies or lose 30 pounds? Some businesses are doing just that and at least one lawsuit has resulted because of it.
• Three hundred businesses have requested assistance from a national employment and labor law firm to institute more aggressive Worksite Wellness Programs.(Cornwell, Lisa, Associated Press, Albuquerque Journal, September 10,2007.)
• Clarian Health, based in Indianapolis, Will start reducing staff member paychecks by $10.00 for every staff member who has a Body Mass Index (BMI) of greater than 29.9 because not enough employees were utilizing their wellness services.(Cornwell, Lisa, Associated Press, Albuquerque Journal, September 10,2007.)
• Scott Rodrigues filed a suit against his prospective employer, Scotts Miracle-Gro, because he believed the organization’s antismoking policy violated his civil rights. The organization has a policy against hiring employees who smoke and Mr. Rodrigues’drug screen was positive for nicotine.(Holland, Kelley, The New York Times,July 22,2007.)
• staff member advocates are concerned that health discrimination may not be covered under the Americans with Disabilities Act.(Cornwell, Lisa, Associated Press, Albuquerque Journal, September 10,2007.)

Penalizing employees by hitting them where it hurts the most,their pocketbook, does not appear to be a favorable approach to molding human behavior.
Such tactics may result in increased resentments and retaliation, primarily in the form of rates of absence and presenteeism (decreased productivity on the job.) Voluntary, incentive-based programs, such as the one in the Washoe County School District, can and do produce results. A positive attitude on the part of management along with an opportunity for employees to have a stake in the decision-making may yield the greatest dividends to both employer and staff member.The motivation and resolve needed to change unhealthy lifestyle habits can best be derived from the basic tenets of encouragement, respect and support.

Stretching programs are another effective tool in injury prevention. According to the Best Practices in Manufacturing Web site, Dayton Parts, Inc. (DPI) in Harrisburg, Pa., conducted research that revealed approximately 80% of all manufacturing injuries occurred within the first two hours of each shift. After starting a program that required production employees to stretch for 10 to 15 minutes at the beginning of their shifts, they saw a dramatic reduction in injuries.

While the DPI Worksite Wellness Program costs about $75,000 a year to operate, in conjunction with other organization programs, it has helped bring the annual cost of workers’ compensation from $700,000 to $200,000 per year.6

To help prevent lengthy absences and reduce workers’ compensation claims, Honda instituted a work recovery program. Through the program, workers who have had an injury can work in a modified job—getting better. Employees in the program spend their work days receiving physical conditioning to increase overall fitness, physical therapy to restore functionality, health education and nutrition counseling. The program is based on information that shows fewer work days are lost when an staff member stays connected to the work environment.

The Ohio Bureau of Workers’ Compensation, www.ohiobwc.com, provides a “10-Step Business Plan” as a guide for businesses in providing Worksite Wellness Programs that aim to reduce injuries. The plan includes information on safety and health programs to prevent occurrences of on-the-job accidents, including:

staff member involvement – To ensure the success of any Worksite Wellness Program, employees must take part in the safety and health-management process. This can be done through safety and health audits, accident investigations, or by forming safety and health involvement teams, focus groups or committees.

Orientation and training plan – Conduct orientation and training sessions to educate employees on the organization’s safety policies. These sessions should include procedures for the safe use of machinery and tools, chemical hazards and how to prevent contact or exposure, specific job/task safe practices, and hazard recognition and prevention.

Communication – Open communication keeps employees informed and provides suggestions and feedback on the effectiveness of the Worksite Wellness Program. Through memos, bulletin boards and staff meetings, important safety and health information can be conveyed throughout the organization, keeping all management staff and employees knowledgeable about the organization’s safe practices.

The organization plan also outlines incentives for post-injury procedures, including:

Medical treatment and return-to-work practices – arly return-to-work strategies help injured or ill workers return to work in a timely manner. Companies should establish a disability management policy to help injured or ill employees obtain quality medical treatment, making their transition back to work quick and effortless.

Timely notification of claims – Employers should document workplace injuries immediately after they occur and promptly send that documentation to a claims handler. Quickly providing claim information demonstrates care and concern for the injured staff member, prevents delays and confusion with the claim process, and reduces the potential for abuse or needless litigation.

Record keeping – Internal documents should be kept to record work-time injuries and to assess the success of the organization’s safety efforts. Employer audits, surveys and injury or illness reports can all be used to analyze which safety practices and policies have proven successful, and what areas of health and wellness need improvement.

The American Association of Family Physicians’ Web site, www.aafp.org, offers a recommended adult immunization schedule created by the Advisory Committee on Immunization Practices. This schedule, tiered by age and chances of exposure, recommends diphtheria, tetanus, influenza, pneumonococcal, hepatitis B, hepatitis C, measles, mumps and rubella, varicella and meningococcal vaccinations.

Ideas to incorporate prevention and early detection:

• Hold a wellness fair and invite organizations that provide screening services for such conditions as blood pressure, blood iron, cholesterol, body mass index (BMI) and diabetes.
• Offer educational materials about well-baby care and immunizations.
• Choose health care coverage plans that include wellness check-ups and immunizations.
• Offer onsite mammograms for employees.
• Sponsor onsite flu vaccinations to coincide with flu season.

While stress cannot be eliminated from life, or even from the workplace, coping skills can be developed with relative ease. Stress management skills lead to reduced rates of absence and more effective, more productive employees. Because stress has been shown to contribute to such physical conditions as ulcers, high blood pressure and stroke, stress reduction has a direct impact on improving physical health.

Studies have shown that heart patients who attend stress management programs have 42% lower health care costs. Other studies have documented a 50% reduction in medical services use when stress management programs are employed. Further, Employee Assistance Program (EAP) experts estimate that 20% of any workforce is affected by personal problems that can influence work performance.

Stress reduction tactics to consider:

• Offer onsite yoga or meditation classes.
• Organize support groups among employees.
• Sponsor stress management classes during the workday.
• Offer an employee assistance program that includes both counseling and referral.
• Offer onsite counseling for employees in the case of a work-related trauma, such as the death of a co-worker.

The old adage “an ounce of prevention is worth a pound of cure” is particularly relevant to when applied to preventive measures taken during pregnancy, when a few extra ounces of birth weight can save a child’s life. During pregnancy, simple precautions can help avoid catastrophic results; giving up smoking, for instance, drastically reduces the risk of miscarriage and pre-term labor.

The March of Dimes reports that if all women took adequate folic acid before conception and during pregnancy, the number of babies born with a neural tube defect could drop by as much as 70%. The physical and emotional benefits of proper prenatal care to a mother and child are underscored by a strong organization case for offering prenatal wellness benefits. Nationwide’s Chief Medical Director, Dr. Michael Moore, estimates costs to care for one baby delivered prematurely could approach $500,000.

First steps in fostering a prenatal program:

• Invite the March of Dimes to present information about prenatal health at an staff member brownbag lunch or breakfast meeting.
• Hold prenatal care information classes for interested employees at lunchtime.
• Offer educational materials about the effects of alcohol, drugs and smoking on an unborn child.
• Offer incentives for adopting healthy lifestyles during pregnancy.
• Offer prenatal programs and education as part of the organization health care package.

Instances of respiratory diseases, cancer and other illnesses can be reduced through smoking cessation efforts. smoking cessation programs can provide huge opportunities for improved health.

The American Cancer Society reports that smoking employees cost businesses an average of $1,429 per smoker per year in increased health care costs over non-smoking employees. Implementing a smoking cessation program costs an average of $45 per staff member per year, saving businesses an average of $1,383 per year for each staff member who quits smoking. Additionally, the American Cancer Society reports that smokers are absent from work 50% more frequently than nonsmokers. They are also 50% more likely to be hospitalized and have 15% higher disability rates. smoking decreases onthe- job productivity as well. Employees who take four 10- minute smoking breaks a day work more than a month less per year than workers who don’t take smoke breaks.

Places to start with smoking cessation programs:

1. Establish a organization policy prohibiting tobacco use anywhere on the property.
2. Offer prompts/posters to support no tobacco use policy.
3. Policy supporting participation in smoking cessation activities during duty time (flex-time).
4. Offer counseling through an individual, group, or telephone counseling program onsite.
5. Offer counseling through a health plan sponsored individual, group, or telephone counseling program.
6. Offer cessation medications through health insurance.